PHYSIOLOGICAL DIAGNOSIS AND SURGICAL-TREATMENT OF RECURRENT LIMB SHAKING - CASE-REPORT

OBJECTIVE AND IMPORTANCE: Although recurrent limb shaking has been obs erved in patients with carotid occlusion, its cause, method of diagnos is, and definitive treatment have yet to be fully elucidated. This rep ort examines the cerebrovascular physiology of a patient with recurren t limb shaking by means of xenon-enhanced computed tomographic (XeCT) scanning. By measuring cerebral blood flow (CBF) and cerebrovascular r eserve capacity, we were able to confirm both the clinical diagnosis a nd the response to treatment on physiological grounds. CLINICAL PRESEN TATION: The patient is a 49-year-old man who presented with frequent b rief attacks of left arm and leg shaking that occurred at standing or coughing. After cervical radiation therapy fora laryngeal carcinoma, h e was found to have bilateral carotid occlusion with minimal collatera l development. XeCT scans revealed borderline ischemic perfusion and l ack of cerebrovascular reserve in response to an acetazolamide vasodil atory challenge. INTERVENTION: The patient underwent a right superfici al temporal artery to middle cerebral artery bypass to augment cerebra l perfusion. CONCLUSION: After the procedure, the patient's limb shaki ng attacks ceased. The postoperative XeCT scan showed improved CBF and a return of cerebrovascular reserve capacity. Recurrent limb shaking is a manifestation of decreased CBF. Quantitative XeCT CBF studies cou pled with vasodilatory challenge is an important way to assess patient s with cerebrovascular disorders and thus identify individuals who wil l benefit from cerebral revascularization.